Pimecrolimus is an immunosuppressant drug of the

calcineurin inhibitor Immunosuppressive drugs, also known as immunosuppressive agents, immunosuppressants and antirejection medications, are drugs that inhibit or prevent the activity of the immune system. Classification Immunosuppressive drugs can be classified ...

class used in the treatment of

atopic dermatitis Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin. Atopic dermatitis is also often called simply eczema but the same term is also used to refer to dermatitis, the larger group of skin conditi ...

(eczema). It is available as a topical cream. It was developed and formerly marketed by

Novartis Novartis AG is a Swiss multinational corporation, multinational pharmaceutical company, pharmaceutical corporation based in Basel, Switzerland. Novartis is one of the largest pharmaceutical companies in the world and was the eighth largest by re ...

under the trade name Elidel.

Medical uses

It has been proven to be effective in various inflammatory skin diseases, e.g.,

seborrheic dermatitis Seborrhoeic dermatitis (also spelled seborrheic dermatitis in American English) is a long-term skin disorder. Symptoms include flaky, scaly, greasy, and occasionally itchy and inflamed skin. Areas of the skin rich in sebum, oil-producing gland ...

, cutaneous lupus erythematosus, oral lichen planus,

vitiligo Vitiligo (, ) is a chronic autoimmune disorder that causes patches of skin to lose pigment or color. The cause of vitiligo is unknown, but it may be related to immune system changes, genetic factors, stress, or sun exposure, and susceptibili ...

, and

psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...

. Tacrolimus and pimecrolimus are both calcineurin inhibitors and function as immunosuppressants.

Atopic dermatitis

If topical

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...

s and moisturisers fail in the treatment of

, short-term treatment with topical calcineurin inhibitors such as

tacrolimus Tacrolimus, sold under the brand name Prograf among others, is an immunosuppressive drug. After Allotransplantation, allogenic organ transplant, the risk of organ Transplant rejection, rejection is moderate. To lower the risk of organ rejectio ...

or pimecrolimus may be tried. Both tacrolimus and pimecrolimus are effective and safe to use in AD.

Side effects

In January 2006, the United States

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respo ...

(FDA) announced that Elidel packaging would be required to carry a

black box warning In the United States, a boxed warning (sometimes "black box warning", colloquially) is a type of warning that appears near the beginning of the package insert for certain prescription drugs, so called because the U.S. Food and Drug Administratio ...

regarding the potential increased risk of

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

skin cancer Skin cancers are cancers that arise from the Human skin, skin. They are due to the development of abnormal cells (biology), cells that have the ability to invade or metastasis, spread to other parts of the body. It occurs when skin cells grow ...

, as for the similar drug

, whereas current practice by UK dermatologists is not to consider this a significant real concern and they are increasingly recommending the use of such new drugs. Importantly, although the FDA has approved updated black-box warning for tacrolimus and pimecrolimus, the recent report of the

American Academy of Dermatology The American Academy of Dermatology (AAD) is a non-profit professional organization of dermatologists in the United States and Canada, based in Rosemont, Illinois, near Chicago. It was founded in 1938 and has more than ''21,000'' members. The Acad ...

Association Task Force finds that there is no causal proof that topical immunomodulators cause

lymphoma Lymphoma is a group of blood and lymph tumors that develop from lymphocytes (a type of white blood cell). The name typically refers to just the cancerous versions rather than all such tumours. Signs and symptoms may include enlarged lymph node ...

or nonmelanoma skin cancer, and systemic immunosuppression after short-term or intermittent long-term topical application seems an unlikely mechanism. Another recent review of evidence concluded that

postmarketing surveillance Postmarketing surveillance (PMS), also known as post market surveillance, is the practice of monitoring the safety of a pharmaceutical drug or medical device after it has been released on the market and is an important part of the science of pharma ...

shows no evidence for this systemic immunosuppression or increased risk for any malignancy. A 2023 systematic review and meta-analysis published in '' The Lancet Child & Adolescent Health'' further concluded with moderate-certainty evidence that the two drugs were not associated with any increased risk of cancer. However, strong debates and controversies continue regarding the exact indications of immunomodulators and their duration of use in the absence of active controlled trials. Dermatologists' and allergists' professional societies, the

, and the

American Academy of Allergy, Asthma, and Immunology Founded in 1943, the American Academy of Allergy, Asthma & Immunology (AAAAI) is a professional medical membership organization of more than 7,000 allergists/ immunologists and related professionals around the world with advanced training and exp ...

, have protested the inclusion of the black box warning. The AAAAI states "None of the information provided for the cases of lymphoma associated with the use of topical pimecrolimus or tacrolimus in AD indicate or suggest a causal relationship."

Pharmacology

Pimecrolimus is an ascomycin macro

lactam A lactam is a Cyclic compound, cyclic amide, formally derived from an amino alkanoic acid through cyclization reactions. The term is a portmanteau of the words ''lactone'' + ''amide''. Nomenclature Greek_alphabet#Letters, Greek prefixes in alpha ...

derivative. It has been shown ''in vitro'' that pimecrolimus binds to FKBP1A and also inhibits

calcineurin Calcineurin (CaN) is a calcium and calmodulin dependent serine/threonine protein phosphatase (also known as protein phosphatase 3, and calcium-dependent serine-threonine phosphatase). It activates the T cells of the immune system and can be block ...

. Thus pimecrolimus inhibits

T-cell T cells (also known as T lymphocytes) are an important part of the immune system and play a central role in the adaptive immune response. T cells can be distinguished from other lymphocytes by the presence of a T-cell receptor (TCR) on their ce ...

activation by inhibiting the synthesis and release of

cytokines Cytokines () are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are produced by a broad range of cells, including immune cells like macrophages, B cell, B lymphocytes, T cell, T lymphocytes ...

from T-cells. Pimecrolimus also prevents the release of inflammatory cytokines and mediators from

mast cell A mast cell (also known as a mastocyte or a labrocyte) is a resident cell of connective tissue that contains many granules rich in histamine and heparin. Specifically, it is a type of granulocyte derived from the myeloid stem cell that is a p ...

s. Pimecrolimus, like tacrolimus, belongs to the ascomycin class of macrolactam immunosuppressives, acting by the inhibition of T-cell activation by the calcineurin pathway and inhibition of the release of numerous inflammatory cytokines, thereby preventing the cascade of immune and inflammatory signals. Pimecrolimus has a similar mode of action to that of tacrolimus but is more selective, with no effect on dendritic (Langerhans) cells. It has lower

permeation In physics and engineering, permeation (also called imbuing) is the penetration of a wikt:permeate#English, permeate (a fluid such as a liquid, gas, or vapor) through a solid. It is directly related to the concentration gradient of the permeate, ...

through the skin than topical steroids or topical tacrolimus although they have not been compared with each other for their permeation ability through mucosa. In addition, in contrast with topical steroids, pimecrolimus does not produce skin atrophy.

Development and production

Pimecrolimus was developed by

. Its development number was ascomycin derivative ''ASM 981''. The

New Drug Application The Food and Drug Administration's (FDA) New Drug Application (NDA) is the vehicle in the United States through which drug sponsors formally propose that the FDA approve a new pharmaceutical for sale and marketing. Some 30% or less of initial ...

(NDA) was filed December 15, 2000. It received US FDA approval on December 13, 2001. At its US approval, it was one of the first new eczema treatments introduced since the topical corticosteroids of the 1950s. It is available as a topical cream, once marketed by Novartis. Since early 2007,

Galderma Galderma SA is an American-Swiss pharmaceutical company specializing in dermatological treatments and skin care products. Formerly a subsidiary of L'Oréal and Nestlé, it was acquired by a consortium of private institutional investors in 20 ...

has been promoting the compound in Canada. The trade name is Elidel.

References

External links

FDA News
* {{Other dermatological preparations Disulfiram-like drugs Immunosuppressants Macrolides Drugs developed by Novartis